Levosimendan as a rescue therapy for low output syndrome after cardiac sugery

Ahmed Saad; Mohamed Elsayed; Ahmed Abdelaziz; Mohamed Gomaa; Amr Rayan

Ahmed Saad Department of Cardiothoracic Surgery, Faculty of Medicine, Alexandria University, Alexandria, Egypt
Mohamed Elsayed Department of Cardiothoracic Surgery, Faculty of Medicine, Alexandria University, Alexandria, Egypt
Ahmed Abdelaziz Department of Cardiothoracic Surgery, Faculty of Medicine, Alexandria University, Alexandria, Egypt
Mohamed Gomaa Department of Anesthesia, Faculty of Medicine, Alexandria University, Alexandria, Egypt
Amr Rayan Department of Cardiothoracic Surgery, Faculty of Medicine, Alexandria University, Alexandria, Egypt

Keywords: Levosimendan, Low cardiac output syndrome, Cardiac surgery, Rescue therapy, Inotrope

Abstract

Background: The calcium sensitizer levosimendan has been shown to improve outcomes in patients with low cardiac output syndrome (LCOS) following cardiac surgery. We assessed its efficacy when used as a rescue therapy in the postoperative setting rather than as a prophylactic preoperative treatment.
Methods: According to our institutional protocol, 18 patients with LCOS that persisted despite conventional inotropic therapy received a 24-hour infusion of levosimendan at 0.1 μg/kg/min. Hemodynamic parameters and clinical outcomes were monitored and statistically analyzed.
Results: Ejection fraction (EF) increased significantly from 29 ± 5% to 41.6 ± 2.7 within 48 hours of initiating levosimendan. This improvement was accompanied by a significant increase in cardiac output from 3.7 ± 0.5 L/min to 5.6 ± 0.8 L/min after 48 hours, along with significant dose reductions in concomitant vasopressors and inotropes. Inotropic support was significantly reduced at the 12-hour assessment compared to the immediate postoperative period and continued to decline over the 48-hour observation window. The norepinephrine dose showed a significant reduction at 48 hours. The overall perioperative mortality was 11%.
Conclusion: Our study suggests that levosimendan is an effective rescue therapy for managing LCOS postoperatively. Its administration should be part of a controlled regimen that avoids unnecessary delays and allows for the concurrent use and monitoring of conventional inotropes.